CASE REPORT
OSTEOCHONDROMA ARISING FROM SPINOUS PROCESS OF L2, L3,
L4 VERTEBRAE WITHOUT SPINAL CORD COMPRESSION: A RARE
PRESENTATION
Santosh Kumar Sahu1, Anant Kumar Garg2, Sanjay Kumar3, Sangram Panda4
HOW TO CITE THIS ARTICLE:
Santosh Kumar Sahu, Anant Kumar Garg, Sanjay Kumar, Sangram Panda.”Osteochondroma Arising from
Spinous Process of L2, L3, L4 Vertebrae without Spinal Cord Compression: A Rare Presentation”. Journal of
Evidence based Medicine and Healthcare; Volume 2, Issue 24, June 15, 2015; Page: 3658-3662.
ABSTRACT: We here with present a case of osteochondroma arising from the spinous process of
L2, L3, L4 vertebrae (Rt. Side) in a 28 years old male, labourer by profession presented to our
hospital OPD on 08/11/2012 with chief complaint of progressive swelling over the Rt. paraspinal
area of lumbar spine for last 1yr. Pain and swelling were gradually increasing. There was no h/ofever, cough or weight loss or urinary complaints or any sensory or motor involvement. X-ray
showed increased density solitary mass at lumbar region (L2, L3, L4). MR imaging showed it to
be contiguous with the spinous process of lumbarvertebrae - L2, L3, L4 suggesting the diagnosis
of osteochondroma, a rare presentation without cord compression, and distinguishing the lesion
from a calcified disk fragment. After thorough investigation we have excised the tumor and sent
for histopathological examination. No residual deficit was found post-operatively. Patient was
relieved of the symptoms and is now under follow-up.
KEYWORDS: Osteochondroma of spinous process of Lumbar spine.
INTRODUCTION: Osteochondroma is a common benign tumor of long bones around knee &
shoulder joints. It commonly occurs in childhood & early adolescents. Osteochondromas are
rarely found in the spine, when present in the spine, however, have a predilection for cervical or
upper thoracic region arising usually from lamina of vertebrae and are rare in lumbosacral region
and very rare at spinous process of the vertebrae. However, this tumor rarely involves the spine
and even more rarely involves the lower lumbar region.[1] They represent 2% of all tumors and
2.6% of the benign tumors of the spine.[2] Presentation of these tumors in spine is usually
circumscribed to the cervical and upper thoracic regions with few tumors presenting in the
lumbosacral vertebrae.[3,4,5] Osteochondroma actually represent a developmental physeal growth
defect. The defect occurs in circumferential ring of fibrous tissue (Perichondrium),”The ring of
Ranvier” covering the epiphyseal plate. Results of such a defect are lateral growth of epiphyseal
cartilage plate instead of normal downward growth towards the metaphysis. This abnormal
growth gives rise to a lateral cartilage protuberance. Whether a stalk or sessile all
osteochondromas have direct communications with the cortex and the marrow cavity of the
underlying bone. The ostechondromas stop growing at the time nearest epiphyseal plate fuses.
CASE REPORT: 28 yrs male laborer by profession presented to our hospital OPD on 08/11/2012
with C/C of progressive swelling over the Rt. paraspinal area of lumbar spine for last 1yr. Pain
and swelling were gradually increasing. There was no h/o- fever, cough or weight loss or urinary
complaints or any sensory or motor involvement. Clinical examination raveled: Hard lump, fixed
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with bone, non mobile, 4cm×6cm in dimension, tender on deep palpation. Overlying skin was
free, local temperature normal& no discharging sinus. MRI scan showed-Rt. L2, L3, L4
Paraspinous lobulated, non-enhancing mixed signal intensity fatty tissue and bone forming mass.
As patient was complaining of pain and increasing size of the swelling. Through Para midline
approach mass was dissected out and was found to be arising from L2, L3, L4 spinous process.
Histopathology showed endochondral ossification on the basal surface of hyaline cartilage, so it
resembles a normal growth plate with rows of chondrocytes. The cartilage is more disorganized
than normal, has binucleate chondrocytes in lacunae, and is covered with a thin layer of
periosteum. No evidence of malignant cells were found.
DISCUSSION: Osteochondroma is more frequent in male and patients are usually under the age
of 20.[3,4,5] From 1-4% of osteochondromas involve the spine and are commonly included in the
posterior elements of the vertebrae. Osteochondroma has a predilection for the cervical and
upper thoracic regions and, as it is in our case, rarely involve Lumbosacral region of the spine.[6]
However the actual incidence is likely to be under estimated because patients are usually
asymptomatic. MRI scan imaging is the best radiological modality for evaluating hyaline cartilage
cap. Differential diagnosis of such lesions include enchondroma, osteoblastoma, osteoid osteoma,
chondroblastoma, hemangioma and chondrosarcoma. osteochondromas are frequently
asymptomatic and development of pain may signify malignant transformation.
CONCLUSION: Osteochondroma of L2, 3, 4 vertebrae is a rare location. Patient is 28yrs old, so
age of presentation is unusual. The lesion was excised en-block & HPE confirmed the lesion to be
osteochondroma.
REFERENCES:
1. Samartzis D, Marco RA: Osteochondroma of the sacrum: A case report and review of the
Literature. Spine 2006, 31 (13): e420-429.
2. Carrera JE, Castillo PA, Molina OM: Lumbar Osteochondroma and radicular compression. A
Case Report. Acta Orthop Men 2007, 21 (5): 261-266.
3. Nejmi K, Ali D, Nebi Y: A Giant Cervical Osteochondroma. Eur J Gen Med 2005, 2 (3): 120122.
4. Arasil E, Erdem A, Yuceer N: Osteochondroma of the uppe cervical spine: A case report.
Spine 1996, 21: 216-218.
5. Ratliff J, Voorhies R: Osteochondroma of the C5 Lamina with cord compression: Case report
and review of the Literature. Spine 2000, 25: 1293-1295.
6. Fiumara E, Scarabino T, Guglielmi G, Bisceglia M, D'Angelo V: Osteochondroma of the L-5
vertebra: a rare cause of sciatic pain. Case report. J Neurosurg 1999, 91 (Suppl 2): 219222.
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Fig. 1: (X-Ray LS Spine AP view)
Fig. 2: (X-Ray LS Spine LAT View)
Fig. 3: (MRI showing hyperintense lesion on T1-Axial)
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Fig. 4: (MRI showing hyperintense lesion on T2-sagittal)
Fig. 5: (Pre-op clinical photo)
Fig. 6: (Excised osteochondroma mass)
Fig. 7: (Endochondral ossification on the basal surface of hyaline cartilage so it resembles a
normal growth plate with rows of chondrocytes. The cartilage is more disorganized than normal,
has binucleate chondrocytes in lacunae, and is covered with a thin layer of periosteum).
Fig. 7
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CASE REPORT
Fig. 8: (Post-op clinical photo showing surgical scar)
AUTHORS:
1. Santosh Kumar Sahu
2. Anant Kumar Garg
3. Sanjay Kumar
4. Sangram Panda
PARTICULARS OF CONTRIBUTORS:
1. Post Graduate, Department of
Orthopaedics, Nilratan Sircar Medical
College & Hospital, Kolkata, West
Bengal.
2. Assistant Professor, Department of
Orthopaedics, Nilratan Sircar Medical
College & Hospital, Kolkata, West
Bengal.
3. Associate Professor, Department of
Orthopaedics, Nilratan Sircar Medical
College & Hospital, Kolkata, West
Bengal.
4. Post Graduate, Department of
Radiodiagnosis, Nilratan Sircar Medical
College & Hospital, Kolkata, West
Bengal.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Santosh Kumar Sahu,
S/o. Sri Rama Chandra Sahu,
Sastrinagar 1st Lane, Gosaninuagaon,
Brahmapur, Ganjam District–760003,
Odisha State.
E-mail: dr.santosh369@gmail.com
Date
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Submission: 04/06/2015.
Peer Review: 05/06/2015.
Acceptance: 07/06/2015.
Publishing: 15/06/2015.
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